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Vaccine Effectiveness Against Influenza A(H1N1), A(H3N2), and B-Associated Hospitalizations, United States, 1 September 2023 to 31 May 2024
No full textBackground: The 2023-2024 influenza season included sustained elevated activity from December 2023 to February 2024 and continued activity through May 2024. Influenza A(H1N1), A(H3N2), and B viruses circulated during the season.
Methods: During 1 September 2023 to 31 May 2024, a multistate sentinel surveillance network of 24 medical centers in 20 US states enrolled adults aged ≥18 years hospitalized with acute respiratory illness. Consistent with a test-negative design, cases tested positive for influenza viruses by molecular or antigen test, and controls tested negative for influenza viruses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccine effectiveness (VE) against influenza-associated hospitalization was calculated as (1 - adjusted odds ratio for vaccination) × 100%.
Results: Among 7690 patients, including 1170 influenza cases (33% vaccinated) and 6520 controls, VE was 40% (95% confidence interval [CI], 31%-48%) with varying estimates by age: 18-49 years, 53% (95% CI, 34%-67%); 50-64 years, 47% (95% CI, 31%-60%); ≥ 65 years, 31% (95% CI, 16%-43%). Protection was similar among immunocompetent patients (40%; 95% CI, 30%-49%) and immunocompromised patients (32%; 95% CI, 7%-50%). VE was statistically significant against influenza B (67%; 95% CI, 35%-84%) and A(H1N1) (36%; 95% CI, 21%-48%) and crossed the null against A(H3N2) (19%; 95% CI, -8% to 39%). VE was higher for patients 14-60 days from vaccination (54%; 95% CI, 40%-65%) than \u3e120 days (18%; 95% CI, -1% to 33%).
Conclusions: During 2023-2024, influenza vaccination reduced the risk of influenza A(H1N1)- and influenza B-associated hospitalizations among adults; effectiveness was lower in patients vaccinated \u3e120 days prior to illness onset compared with those vaccinated 14-60 days prior.
Keywords: hospitalization; seasonal influenza; severe influenza; vaccine effectiveness; waning
Insurance Denials for Fluoride Varnish and Well-Child Visits
No full textThis cross-sectional study examines rates of insurance claim denials for fluoride varnish treatment and well-child medical visits among US children
Negative social determinants of health are linked to lung cancer screening underutilization
No full textIntroduction: This study aimed to examine the association between social determinants of health (SDOH) and lung cancer screening (LCS) utilization.
Methods: We analyzed data from 15,957 LCS-eligible individuals in the 2022 Behavioral Risk Factor Surveillance System survey. Primary outcomes included ever having (lifetime) LCS and meeting LCS recommendations (i.e., annual LCS). Multivariable logistic regression models examined associations between LCS outcomes and 12 adverse SDOH factors, controlling for covariates (i.e., demographics, diagnosis of asthma/COPD, and perceived general health status).
Results: LCS-eligible individuals with more adverse SDOH had lower odds of ever having LCS and being up to date. Those with ≥5 adverse SDOH had the lowest odds of having lifetime LCS (AOR = 0.58, 95%CI: 0.45-0.74) and meeting LCS recommendations (AOR = 0.49, 95%CI: 0.36-0.65) compared to those with none. Life dissatisfaction, lack of social and emotional support, housing insecurity, lack of health insurance, and cost as a barrier for needed medical care were independently associated with lower LCS uptake.
Conclusions: Having more adverse SDOH was associated with a lower likelihood of having lifetime LCS and meeting the recommendation, with life dissatisfaction, lack of social and emotional support, housing insecurity, lack of health insurance, and medical care cost being independently associated factors.
Keywords: Lung cancer; SDOH; lung cancer screening; smoking; social determinants of health. Plain language summary
Lung cancer screening (LCS) remains low among eligible populations.People with more adverse social determinants of health (SDOH) had lower odds of having a lifetime LCS.People with more adverse SDOH are also less likely to meet LCS recommendations.Lack of social and emotional support, housing insecurity, and lack of health insurance were associated with lower odds of having a lifetime LCS.Life dissatisfaction, lack of social and emotional support, lack of health insurance, and cost as a medical care barrier were associated with lower odds of meeting the LCS recommendation
Advances in VT ablation for arrhythmogenic cardiomyopathy: evidence, mapping and ablation strategies, and predictive factors
No full textCatheter ablation of ventricular tachycardia (VT) in arrhythmogenic cardiomyopathy (ACM) is a crucial yet challenging procedure, given the evolving disease definitions, diverse subtypes, genetic variability, complexities in risk stratification, and the intricate substrate distribution characteristic of this condition. Initially described as a right ventricular cardiomyopathy (ARVC), ACM now encompasses left-dominant (ALVC) and biventricular (ABVC) phenotypes, driven by desmosomal (e.g., DSP, PKP2) and non-desmosomal (e.g., FLNC, LMNA) mutations, with fibrosis as the primary arrhythmic substrate. Catheter ablation, particularly combined endocardial-epicardial approaches, reduces VT burden but faces high recurrence rates in younger patients and those with extensive scarring. In this review, we critically assess the role of VT ablation in ACM, current evidence, available techniques for mapping and ablation, outcomes and predictors of success of the ablation procedure in this patient group.
Keywords: Arrhythmogenic cardiomyopathy (ACM); Arrhythmogenic right ventricular cardiomyopathy (ARVC); Catheter ablation (CA); Sudden cardiac death (SCD); Ventricular tachycardia (VT)
Percutaneous micro-axial flow pump use during non-emergent high-risk PCI: Systematic review and meta-analysis
No full textBackground: Percutaneous micro-axial flow pumps (mAFP) are increasingly used for hemodynamic support during high-risk percutaneous coronary interventions (PCI) despite limited evidence supporting their effectiveness. We conducted a meta-analysis to assess the effectiveness and safety of mAFP use during non-emergent high-risk PCI procedures.
Methods: Electronic databases were searched for studies comparing percutaneous mAFP versus control for non-emergent high-risk PCI. The primary outcome was the incidence of major adverse cardiac events (MACE).
Results: Eight studies (one randomized, seven observational) with 4688 patients were included. There were no significant differences in the risk of MACE within 30 days (RR 1.34; 95 % CI 0.73-2.47) or at 1 year (RR 1.08; 95 % CI 0.58-1.98) in patients treated with vs. without a mAFP during high-risk PCI. Nor was the risk of mortality different between groups. Peri-procedural complications, including acute kidney injury, major bleeding, blood transfusions, myocardial infarction, and stroke, were not increased with the mAFP. The subgroup of patients who received mAFP prior to PCI again had similar risk of MACE and mortality compared with the control. However, in this group, mAFP use was associated with higher in-hospital risks of major bleeding (RR 2.77; 95 % CI 1.28-5.98) and blood transfusion (RR 2.20; 95 % CI 1.17-4.15) and of in-hospital or 30-day myocardial infarction (RR 1.68; 95 % CI 1.03-2.73).
Conclusions: mAFP use was not associated with improved outcomes among patients undergoing non-emergent high-risk PCI. Given the potential for selection bias, ongoing large-scale randomized trials are necessary to determine its impact on efficacy and safety.
Social media abstract: In 4688 patients undergoing non-emergent high-risk PCI, use of a percutaneous micro-axial flow pump did not reduce MACE or mortality at 30 days or 6 months, and pre-PCI use was linked to higher risks of bleeding and in-hospital MI, warranting further large-scale trials.
Keywords: Impella; Mechanical circulatory support; Meta-analysis; Micro-axial flow pumps; Percutaneous coronary intervention
Fractional Flow Reserve Versus Intravascular Imaging to Guide Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
No full textStreamlining Memory Assessment and Care Clinic Intake to Maximize Provider Consult Time
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1016/thumbnail.jp
Improving Patient Outcomes Through 72-Hour Post-Indwelling Urinary Catheter Perineal Care
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1004/thumbnail.jp
Catheter Ablation Versus Medical Therapy as First-Line Treatment for Ventricular Electrical Storm: A Systematic Review and Meta-Analysis
No full textBackground: Electrical storm (ES) is a life-threatening manifestation of recurrent ventricular arrhythmia. While anti-arrhythmic drugs (AADs) have historically been the first-line treatment, the role of catheter ablation (CA) as an initial therapy in ES remains incompletely defined. This meta-analysis evaluates the efficacy and safety of radiofrequency CA compared to escalating medical therapy in patients with ES.
Methods: A systematic search of PubMed, Science Direct, and Cochrane databases was conducted for studies published from 2010 to 2025 that compared CA with medical therapy as first-line treatment for ES. Outcomes of interest included ES recurrence, ventricular arrhythmia recurrence, in-hospital mortality, procedural complications, and follow-up survival. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.
Results: Six studies encompassing 963 patients (473 CA, 490 medical therapy) were included. The mean age was 67.8 years, and 87.7% were male. The mean left ventricular ejection fraction was 33%, and ischemic cardiomyopathy was present in 77.5% of CA and 72.1% of MT patients. CA reduced the risk of ES recurrence by 71% compared to medical therapy (OR: 0.29; 95% CI: 0.15-0.53; p \u3c 0.001; I² = 53%). Recurrence of any ventricular arrhythmia, in-hospital mortality, and long-term survival were also significantly improved with CA.
Conclusion: This meta-analysis suggests that CA is associated with lower ES and VA recurrence and in-hospital mortality and improved survival compared to medical therapy alone. These findings support consideration of catheter ablation as a first-line strategy. Larger prospective trials are needed to confirm these findings and guide patient selection.
Keywords: catheter ablation; electrical storm; outcomes; ventricular arrhythmia; ventricular tachycardia
Marginal Dispositions and Shared Decision-Making Among Older Adults in the ED: A Prospective Cohort Study
No full textBackground: ED disposition decisions for older adults are complex and often uncertain, yet studies rarely capture emergency physicians\u27 real-time perspectives.
Objective: To assess patient outcomes based on emergency physician-perceived need for admission.
Design: Single-site prospective cohort study conducted between July and November 2024.
Setting: A Boston-area academic tertiary care ED.
Participants: Patients aged 65 and older dispositioned by attending physicians, excluding patients who were handed off, left without being seen, or eloped.
Measurements: Physicians rated admission need using a 5-point Likert scale (2-4 considered marginal). Primary outcome was ED disposition stratified by rating. Secondary outcomes were hospital length-of-stay (LOS), 7-day ED return, and 30-day mortality.
Results: Of the 489 patients (mean age 76.9 years [SD 7.5], 51.1% female), 55.8% were non-marginal admissions, 26.0% were non-marginal discharges, and 18.2% were marginal dispositions. Patients with marginal dispositions had longer workup times than non-marginal admissions or discharges (3.3 vs. 2.8 vs. 2.4 h, p \u3c 0.05). Thirty-day mortality was greater for non-marginal admissions (8.8%) than non-marginal discharges (1.6%, p = 0.01), but not significantly different than marginal dispositions (3.4%). Marginal admissions had shorter median LOS (3.1 vs. 5 days, p \u3c 0.01) and higher early discharge rates (27.8% vs. 13.2%, p = 0.01) than non-marginal admissions. Marginal discharges had fewer 7-day returns than non-marginal discharges (0% vs. 11.7%, p = 0.04). For marginal cases, physicians discussed admission benefits more than risks (70.1% vs. 43.3%, p \u3c 0.01) for marginal cases.
Limitations: Single-site and need for admission were reported contemporaneous with disposition decision.
Conclusions: One in six older adult ED dispositions was identified as marginal. These patients are potential targets for shared decision-making and alternative care pathways